DESCRIPTION: HIV-positive adults who live in rural areas suffer from greater mortality than non-rural HIV-infected individuals and face unique challenges to maintaining good health. This disparity in health outcomes is not well understood, yet remains significant because a sizeable number of HIV-positive individuals live in rural areas. To minimize morbidity and mortality, all HIV-positive individuals must remain engaged in care and adherent to antiretroviral medications over the course of their lives. Services such as expert HIV care, case management, mental health care, and antiretroviral adherence support can improve health outcomes for HIV-infected individuals, but may be unavailable or more difficult to access for individuals living in rural ares. Additional factors challenge rural HIV-infected individuals, including transportation, social isolation, increased stigma, higher rates of depression, and more maladaptive coping mechanisms. As the HIV population in the US ages-more than half of HIV-infected individuals in the US will be over age 50 by 2015-access to medical care and ancillary services will become increasingly important to maintain good health outcomes. While the individual sets of challenges of aging with HIV and living with HIV in a rural environment are each significant, older HIV-positive individuals who live in rural areas face a doubly difficult set of challenges to achieving good health outcomes. Currently, little is known about the factors that affect (1) engagement in HIV-related care, and (2) health-related quality of life among older, rural HIV-positive adults. This project will elucidate the unique personal, social, and structural factors tht affect health-related quality of life and engagement in medical care among older, rural HIV-positive adults and determine the effect of these factors on health outcomes. To accomplish these goals, this project will use a mixed-methods approach. During the formative, qualitative phase of the study, in-depth individual interviews will be conducted with approximately 40 HIV-positive adults over the age of 50 who live in rural areas of the US. These interviews will elucidate the personal, psychosocial, medical, structural, geographic, and demographic factors that affect perceived quality of life as well as engagement in medical care. Using data from the formative phase of the study, a survey will be constructed to measure (1) the prevalence of each factor in a large sample; (2) which factors are associated with engagement in medical care and quality of life; and (3) the degree to which each factor is associated with these outcomes. During this phase of the study, 400 HIV-positive adults over age 50 who live in rural areas throughout the US will complete this survey. Analyses of survey data will determine the specific needs of this population, and the factors that have the greatest effect on quality of life and engagement in medical care. This project will yield data which is of great public health significance, as it will demonstrate the current needs of this population of US HIV-positive individuals that suffer from greater mortality and will serve as a basis from which to develop interventions to improve health outcomes and reduce health disparities for this population.